Provider Demographics
NPI:1093179509
Name:MK INFUSION PHARMACY LLC
Entity Type:Organization
Organization Name:MK INFUSION PHARMACY LLC
Other - Org Name:MK INFUSION PHARMACY, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PHARMACIST / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-320-7611
Mailing Address - Street 1:307 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2835
Mailing Address - Country:US
Mailing Address - Phone:256-320-7611
Mailing Address - Fax:256-320-7607
Practice Address - Street 1:307 W STATE ST
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2835
Practice Address - Country:US
Practice Address - Phone:256-320-7611
Practice Address - Fax:256-320-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14795/7.1332BP3500X
TN0000005791333600000X
AL1146173336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL187872Medicaid
2159515OtherPK